Background & Aims. The coronavirus disease 2019 (COVID-19) has caused millions of deaths worldwide, making the uptake of effective vaccines critical to saving lives. In Sierra Leone and Zimbabwe, both supply- and demand-side challenges have made high rates of vaccination difficult to achieve. The current study seeks to describe vaccination rates and reasons for vaccine hesitancy in both Sierra Leone and Zimbabwe. 
 Methods. The current study uses data that came from a cross sectional survey that was conducted face to face in Sierra Leone and Zimbabwe. This study uses frequency statistics, chi-square test statistics, and multivariate regression analysis to describe and explore differences between the two countries. The Health Belief Model was used as a framework for sorting and understanding findings.
 Results and Conclusions. This study reveals that vaccine uptake was much lower in Sierra Leone than in Zimbabwe. Zimbabweans were almost twice as likely as Sierra Leoneans to be vaccinated while Sierra Leoneans were significantly more likely to believe the vaccine was risky. Individuals who were older, from Zimbabwe, and were healthcare workers or community leaders were more likely to be vaccinated. Those who were from Zimbabwe, had secondary or tertiary education, and were community leaders were more likely to be concerned about catching COVID-19 than community members. Faith leaders were less likely to be concerned about catching COVID-19 in public. These findings add to our understanding of attitudes that lead to vaccine hesitancy and uptake.